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Regular HIV RNA testing for all HIV positive patients on antiretroviral therapy (ART) is expensive and has low yield since most tests are undetectable. Selective testing of those at higher risk of failure may improve efficiency. We investigated whether a novel analysis of adherence data could correctly classify virological failure and potentially inform a selective testing strategy.

Design

Multisite prospective cohort consortium.

Methods

We evaluated longitudinal data on 1478 adult patients treated with ART and monitored using the Medication Event Monitoring System (MEMS) in 16 United States cohorts contributing to the MACH14 consortium. Since the relationship between adherence and virological failure is complex and heterogeneous, we applied a machine-learning algorithm (Super Learner) to build a model for classifying failure and evaluated its performance using cross-validation.

Results

Application of the Super Learner algorithm to MEMS data, combined with data on CD4+ T cell counts and ART regimen, significantly improved classification of virological failure over a single MEMS adherence measure. Area under the ROC curve, evaluated on data not used in model fitting, was 0.78 (95% CI: 0.75, 0.80) and 0.79 (95% CI: 0.76, 0.81) for failure defined as single HIV RNA level >1000 copies/ml or >400 copies/ml, respectively. Our results suggest 25–31% of viral load tests could be avoided while maintaining sensitivity for failure detection at or above 95%, for a cost savings of $16–$29 per person-month.

United States, Department of Health and Human Services., Panel on Clinical Practices for the Treatment of HIV Infection.. Centers for Disease Control and Prevention (U.S.). National Center for HIV, STD, and TB Prevention (U.S.), Division of HIV/AIDS Prevention--Surveillance and Epidemiology..

The availability of an increasing number of antiretroviral agents and the rapid evolution of new information has introduced substantial complexity into treatment regimens for persons infected with human immunodeficiency virus (HIV). In 1996, the Depa...

Although Roche COBAS Ampliprep/COBAS TaqMan (CAP/CTM) systems are widely used in sub-Saharan Africa for early infant diagnosis of HIV from dried blood spots (DBS), viral load monitoring with this system is not practical due to nonspecific extraction ...

Centers for Disease Control and Prevention (U.S.), Public Health Service Task Force.. National Center for HIV, STD, and TB Prevention (U.S.), Division of HIV/AIDS Prevention--Surveillance and Epidemiology.. United States, Public Health Service., Perinatal HIV Guidelines Working Group..

"These recommendations update the February 4,2002, guidelines developed by the Public Health Service for the use of zidovudine (ZDV) to reduce the risk for perinatal human immunodeficiency virus type 1 (HIV-1) transmission. This report provides healt...

Panel on Clinical Practices for the Treatment of HIV Infection (U.S.). Centers for Disease Control and Prevention (U.S.). National Institutes of Health (U.S.). Office of AIDS Research. Advisory Council..

Published:

February 12, 2013

Description:

Antiretroviral therapy (ART) for the treatment of HIV infection has improved steadily since the advent of potent combination therapy in 1996. New drugs that offer new mechanisms of action, improvements in potency and activity even against multidrug-r...

Centers for Disease Control and Prevention (U.S.). Centers for Disease Control and Prevention (U.S.). Henry J. Kaiser Family Foundation. National Center for Infectious Diseases (U.S.), Division of AIDS, STD, and TB Laboratory Research.. National Center for HIV, STD, and TB Prevention (U.S.), Division of HIV/AIDS Prevention–Surveillance, and Epidemiology.. National Institute of Health (U.S.), Panel to Define Principles of Therapy of HIV Infection.. United States, Department of Health and Human Services., Panel on Clinical Practices for the Treatment of HIV Infection..

Report of the NIH Panel to Define Principles of Therapy of HIV Infection: Recent research advances have afforded substantially improved understanding of the biology of human immunodeficiency virus (HIV) infection and the pathogenesis of the acquired ...